TRT Eligibility & Contraindications, OPTML

✓You are likely a fit if

TRT is appropriate for men with both clinical symptoms and confirmed low testosterone on labs, not one or the other.

Two morning total testosterone readings below ~300 ng/dL (some labs use 264 as the threshold), drawn between 7-10am, fasting.
Clear symptoms: low libido, erectile changes, persistent fatigue, decline in mood, loss of strength, low energy, brain fog.
Free testosterone is also low (or SHBG is elevated, masking a real deficit).
You are not actively trying to conceive, or you understand TRT will suppress fertility.
You're committed to follow-up labs at week 8-12 and every 6 months.

×Hard contraindications, we will not prescribe

If any of these apply, TRT is off the table at OPTML.

Active prostate cancer, or history of prostate cancer not in long-term remission with urology clearance.
Active breast cancer in men.
Untreated severe obstructive sleep apnea.
Hematocrit above 54% at baseline (polycythemia).
Severe untreated benign prostatic hyperplasia (BPH) with significant lower urinary tract symptoms.
Uncontrolled heart failure (NYHA class IV).
Recent (within 6 months) stroke, MI, or unstable cardiovascular disease.
Active desire to father a child within the next 6-12 months, we'll route you to enclomiphene instead.
Known hypersensitivity to testosterone esters or carrier oils.

!Conditions that require extra care

Manageable, but the protocol is adjusted and monitoring is more frequent.

PSA elevated for age, urology evaluation required before starting.
Hematocrit 50-54%, we'll start lower, dose more frequently (subq twice-weekly), and may require periodic phlebotomy.
BPH on alpha-blocker or 5-AR inhibitor, manageable; coordinate with your urologist.
Treated obstructive sleep apnea, OK if CPAP-adherent; we'll monitor.
History of DVT/PE, relative contraindication; physician will weigh risk.
Significant CVD with stable management, possible with cardiology coordination.
Mood disorder or unstable mental health, TRT can amplify; we screen and we coordinate.
Future fertility may be desired, we'll discuss enclomiphene first or hCG add-on.

Pre-start labs we require

Upload existing labs from the past 6 months or use the OPTML Optimized Health (Male) panel.

Lab	Why
Total testosterone (AM, fasting) × 2	Confirms diagnostic threshold.
Free testosterone & SHBG	Real bioavailable T; SHBG can mask true deficit.
Estradiol (sensitive assay)	Aromatization baseline.
LH & FSH	Primary vs. secondary hypogonadism.
CBC (hemoglobin, hematocrit)	Polycythemia risk.
PSA	Required if age ≥ 40 or family history of prostate cancer.
CMP, lipids, A1c	Cardiometabolic baseline.
TSH, prolactin	Rule out other causes of low T.

What to disclose at intake

All of these change the protocol. Hidden facts always surface.

Any current or past anabolic steroid, SARM, or peptide use, with dates and dosing.
Any prior TRT, brand, dose, frequency, duration, why you stopped.
Family history of prostate or breast cancer.
Sleep apnea status: diagnosed, treated, or never tested.
Plans for future children, even uncertain plans.
Mental health history.
All current medications, including blood thinners.

Weight-loss medication disclaimer

OPTML offers compounded semaglutide and tirzepatide, prescribed and overseen by U.S.-licensed physicians. Compounded drug products are not approved or evaluated for safety, effectiveness, or quality by the FDA. OPTML is not associated with, endorsed by, or affiliated with the manufacturers of FDA-approved branded weight-loss medications, and does not sell or supply those branded products. Anyone interested in an FDA-approved branded medication should consult a licensed healthcare provider or pharmacist. Individual results vary; no specific result is promised, and weight management requires ongoing medical guidance.

Who can, and can't, start TRT.

✓You are likely a fit if

×Hard contraindications, we will not prescribe

!Conditions that require extra care

Pre-start labs we require

What to disclose at intake

Don't start TRT without screening.

The complete GLP-1 guide

Unlock the free
guide to keeping muscle

Who can, and can't, start TRT.

✓You are likely a fit if

×Hard contraindications, we will not prescribe

!Conditions that require extra care

Pre-start labs we require

What to disclose at intake

Don't start TRT without screening.

The complete GLP-1 guide

Unlock the freeguide to keeping muscle

Unlock the free
guide to keeping muscle